Acta Neurochirurgica

, Volume 158, Issue 5, pp 933–942 | Cite as

Reasons and results of endoscopic surgery for prolactinomas: 142 surgical cases

  • Safak Akin
  • Ilkay Isikay
  • Figen Soylemezoglu
  • Taskin Yucel
  • Alper Gurlek
  • Mustafa BerkerEmail author
Clinical Article - Functional



We report herein a retrospective analysis of the results of 142 consecutive prolactinoma cases operated upon using an endoscopic endonasal trans-sphenoidal approach over a period of 6 years.


Medical records of 142 cases were analysed with respect to indications for surgery, duration of hospital stay, early remission rates, failures and recurrence rates during a median follow-up of 36 months.


On the basis of magnetic resonance imaging (MRI) data, 19 patients (13.4 %) had microadenoma, 113 (79.6 %) had macroadenoma, and the remaining 10 (7.0 %) had giant adenomas. Cavernous sinus invasion was identified in 25 patients by MRI and confirmed during surgery. Atypical adenoma was diagnosed in 16 patients. Sparsely granulated prolactin adenoma was identified in 99 patients (69.7 %). Our results demonstrate that male sex and higher preoperative prolactin levels are independent factors predicting persistent disease. The post-surgical complications are as follows: 2.8 % patients had meningitis, 2.1 % patients had postoperative cerebrospinal fluid leak and 2.1 % patients had panhypopituitarism. At the end of follow-up, 74.6 % patients went into remission. During follow-up period, five patients who had initial remission developed recurrence.


Our series together with literature data suggest that an endoscopic endonasal trans-sphenoidal approach in the treatment of proloctinomas has a favourable rate of remission. According to the findings of this study, endoscopic endonasal trans-sphenoidal surgery might be an appropriate therapy choice for patients with prolactinoma who could not have been managed with recommended therapeutic modalities.


Atypical prolactin adenoma Endoscopic endonasal trans-sphenoidal pituitary surgery Pituitary apoplexy Prolactinoma Sparsely granulated prolactin adenoma 



We are thankful to Mr. Khawar Ali for his contributions to English language editing of this manuscript.

Compliance with ethical standards

For this type of study formal consent is not required.


No funding was received for this research.

Conflicts of interest



  1. 1.
    Acharya SV, Gopal RA, Menon PS, Bandgar TR, Shah NS (2010) Giant prolactinoma and effectiveness of medical treatment. Endocr Pract 16:42–46CrossRefPubMedGoogle Scholar
  2. 2.
    Almalki MH, Buhary B, Alzahrani S, Alshahrani F, Alsherbeni S, Alhowsawi G, Aljohani N (2015) Giant prolactinomas: clinical manifestations and outcomes of 16 Arab cases. Pituitary 18:405–409CrossRefPubMedGoogle Scholar
  3. 3.
    Amar AP, Couldwell WT, Chen JC, Weiss MH (2002) Predictive value of serum prolactin levels measured immediately after transsphenoidal surgery. J Neurosurg 97:307–314CrossRefPubMedGoogle Scholar
  4. 4.
    Amit Kumar Thotakura AK, Mohana Rao Patibandla MR, Manas K. Panigrahi MK, Gokul Chowdary Addagada GC (2015) Predictors of visual outcome with transsphenoidal excision of pituitary adenomas having suprasellar extension: a prospective series of 100 cases and brief review of the literature. Asian J Neurosurg. doi:10.4103/1793-5482.149995Google Scholar
  5. 5.
    Babey M, Sahli R, Vajtai I, Andres RH, Seiler RW (2010) Pituitary surgery for small prolactinomas as an alternative to treatment with dopamine agonists. Pituitary 14:222–230CrossRefPubMedCentralGoogle Scholar
  6. 6.
    Bates AS, Farrell WE, Bicknell EJ, McNicol AM, Talbot AJ, Broome JC, Perrett CW, Thakker RV, Clayton RN (1997) Allelic deletion in pituitary adenomas reflects aggressive biological activity and has potential value as a prognostic marker. J Clin Endocrinol Metab 82:818–824PubMedGoogle Scholar
  7. 7.
    Berezin M, Shimon I, Hadani M (1995) Prolactinoma in 53 men: clinical characteristics and modes of treatment (male prolactinoma). J Endocrinol Investig 18:436–441CrossRefGoogle Scholar
  8. 8.
    Berker M, Hazer DB, Yucel T, Gurlek A, Cila A, Aldur M, Onerci M (2012) Complications of endoscopic surgery of the pituitary adenomas: analysis of 570 patients and review of the literature. Pituitary 15:288–300CrossRefPubMedGoogle Scholar
  9. 9.
    Berkmann S, Schlaffer S, Nimsky C, Fahlbusch R, Buchfelder M (2014) Intraoperative high-field MRI for transsphenoidal reoperations of nonfunctioning pituitary adenoma. J Neurosurg 121:1166–1175CrossRefPubMedGoogle Scholar
  10. 10.
    Cappabianca P, Cavallo LM, de Divitiis O, de Angelis M, Chiaramonte C, Solari D (2015) Endoscopic endonasal extended approaches for the management of large pituitary adenomas. Neurosurg Clin N Am 26:323–331CrossRefPubMedGoogle Scholar
  11. 11.
    Carija R, Vucina D (2012) Frequency of pituitary tumor apoplexy during treatment of prolactinomas with dopamine agonists: a systematic review. CNS Neurol Disord Drug Targets 11:1012–1014CrossRefPubMedGoogle Scholar
  12. 12.
    Carter JN, Tyson JE, Tolis G, Van Vliet S, Faiman C, Friesen HG (1978) Prolactin-screening tumors and hypogonadism in 22 men. N Engl J Med 299:847–852CrossRefPubMedGoogle Scholar
  13. 13.
    Chabot JD, Chakraborty S, Imbarrato G, Dehdashti AR (2015) Evaluation of outcomes after endoscopic Endonasal surgery for large and giant pituitary Macroadenoma: a retrospective review of 39 consecutive patients. World Neurosurg 84(4):978–988CrossRefPubMedGoogle Scholar
  14. 14.
    Chng E, Dalan R (2013) Pituitary apoplexy associated with cabergoline therapy. J Clin Neurosci 20:1637–1643CrossRefPubMedGoogle Scholar
  15. 15.
    Choe JH, Lee KS, Jeun SS, Cho JH, Hong YK (2008) Endocrine outcome of endoscopic endonasal transsphenoidal surgery in functioning pituitary adenomas. J Korean Neurosurg Soc 44:151–155CrossRefPubMedPubMedCentralGoogle Scholar
  16. 16.
    Ciccarelli A, Daly AF, Beckers A (2005) The epidemiology of prolactinomas. Pituitary 8:3–6CrossRefPubMedGoogle Scholar
  17. 17.
    Colao A, Sarno AD, Cappabianca P, Briganti F, Pivonello R, Somma CD, Faggiano A, Biondi B, Lombardi G (2003) Gender differences in the prevalence, clinical features and response to cabergoline in hyperprolactinemia. Eur J Endocrinol 148:325–331CrossRefPubMedGoogle Scholar
  18. 18.
    Corsello SM, Ubertini G, Altomare M, Lovicu RM, Migneco MG, Rota CA, Colosimo C (2003) Giant prolactinomas in men: efficacy of cabergoline treatment. Clin Endocrinol 58:662–670CrossRefGoogle Scholar
  19. 19.
    de Paiva Neto MA, Vandergrift A, Fatemi N, Gorgulho AA, Desalles AA, Cohan P, Wang C, Swerdloff R, Kelly DF (2010) Endonasal transsphenoidal surgery and multimodality treatment for giant pituitary adenomas. Clin Endocrinol 72:512–519CrossRefGoogle Scholar
  20. 20.
    Dehdashti AR, Ganna A, Witterick I, Gentili F (2009) Expanded endoscopic endonasal approach for anterior cranial base and suprasellar lesions: indications and limitations. Neurosurgery 64:677–687CrossRefPubMedGoogle Scholar
  21. 21.
    Delgrange E, Trouillas J, Maiter D, Donckier J, Tourniaire J (1997) Sex-related difference in the growth of prolactinomas: a clinical and proliferation marker study. J Clin Endocrinol Metab 82:2102–2107PubMedGoogle Scholar
  22. 22.
    Gnanalingham KK, Bhattacharjee S, Pennington R, Ng J, Mendoza N (2005) The time course of visual field recovery following transphenoidal surgery for pituitary adenomas: predictive factors for a good outcome. J Neurol Neurosurg Psychiatry 76:415–419CrossRefPubMedPubMedCentralGoogle Scholar
  23. 23.
    Gurlek A, Karavitaki N, Ansorge O, Wass JA (2007) What are the markers of aggressiveness in prolactinomas? Changes in cell biology, extracellular matrix components, angiogenesis and genetics. Eur J Endocrinol 156:143–153CrossRefPubMedGoogle Scholar
  24. 24.
    Hulting AL, Muhr C, Lundberg PO, Werner S (1985) Prolactinomas in men: clinical characteristics and the effect of bromocriptine treatment. Acta Med Scand 217:101–109CrossRefPubMedGoogle Scholar
  25. 25.
    Komotar RJ, Starke RM, Raper DM, Anand VK, Schwartz TH (2012) Endoscopic endonasal compared with microscopic transsphenoidal and open transcranial resection of giant pituitary adenomas. Pituitary 15:150–159CrossRefPubMedGoogle Scholar
  26. 26.
    Kontogeorgos G, Horvath E, Kovacs K, Coire C, Lloyd RV, Scheithauer BW, Smyth HS (2006) Morphologic changes of prolactin-producing pituitary adenomas after short treatment with dopamine agonists. Acta Neuropathol 111:46–52CrossRefPubMedGoogle Scholar
  27. 27.
    Kreutzer J, Buslei R, Wallaschofski H, Hofmann B, Nimsky C, Fahlbusch R, Buchfelder M (2008) Operative treatment of prolactinomas: indications and results in a current consecutive series of 212 patients. Eur J Endocrinol 158:11–18CrossRefPubMedGoogle Scholar
  28. 28.
    Kupersmith MJ, Kleinberg D, Warren FA, Budzilovitch G, Cooper P (1989) Growth of prolactinoma despite lowering of serum prolactin by bromocriptine. Neurosurgery 24:417–423CrossRefPubMedGoogle Scholar
  29. 29.
    Landolt AM, Osterwalder V (1984) Perivascular fibrosis in prolactinomas: is it increased by bromocriptine? J Clin Endocrinol Metab 58:1179–1183CrossRefPubMedGoogle Scholar
  30. 30.
    Liu JK, Couldwell WT (2004) Contemporary management of prolactinomas. Neurosurg Focus 16, E2PubMedGoogle Scholar
  31. 31.
    Lloyd RK, Young WF Jr, Farrel WE, Asa SL, Trouillas J, Kontogeorgeos G, Sano T, Scheithauer BW, Horvath E (2004) Pituitary tumors: introduction. World Health Organization classification of tumours. Pathology and genetics of tumours of endocrine organs. IARC Press, LyonGoogle Scholar
  32. 32.
    Maiter D, Delgrange E (2014) Therapy of endocrine disease: the challenges in managing giant prolactinomas. Eur J Endocrinol 170:R213–R227CrossRefPubMedGoogle Scholar
  33. 33.
    Maiter D, Primeau V (2012) 2012 update in the treatment of prolactinomas. Ann Endocrinol 73:90–98CrossRefGoogle Scholar
  34. 34.
    Martin CH, Schwartz R, Jolesz F, Black PM (1999) Transsphenoidal resection of pituitary adenomas in an intraoperative MRI unit. Pituitary 2:155–162CrossRefPubMedGoogle Scholar
  35. 35.
    Mindermann T, Wilson CB (1994) Age-related and gender-related occurrence of pituitary adenomas. Clin Endocrinol 41:359–364CrossRefGoogle Scholar
  36. 36.
    Molitch ME (2014) Management of medically refractory prolactinoma. J Neurooncol 117:421–428CrossRefPubMedGoogle Scholar
  37. 37.
    Molitch ME, Thorner MO, Wilson C (1997) Management of prolactinomas. J Clin Endocrinol Metab 82:996–1000CrossRefPubMedGoogle Scholar
  38. 38.
    Morange I, Barlier A, Pellegrini I, Brue T, Enjalbert A, Jaquet P (1996) Prolactinomas resistant to bromocriptine: long term efficacy of quanoglide and outcome of pregnancy. Eur J Endocrinol 135:413–420CrossRefPubMedGoogle Scholar
  39. 39.
    Nakao N, Itakura T (2011) Surgical outcome of the endoscopic endonasal approach for non-functioning giant pituitary adenoma. J Clin Neurosci 18:71–75CrossRefPubMedGoogle Scholar
  40. 40.
    Raverot G, Wierinckx A, Dantony E, Auger C, Chapas G, Villeneuve L, Brue T, Figarella-Branger D, Roy P, Jouanneau E, Jan M, Lachuer J, Trouillas J, Hypopronos (2010) Prognostic factors in prolactin pituitary tumors: clinical, histological, and molecular data from a series of 94 patients with a long postoperative follow-up. J Clin Endocrinol Metab 95:1708–1716CrossRefPubMedGoogle Scholar
  41. 41.
    Saeger W (1996) Current pathological classification of pituitary adenomas. Acta Neurochir Suppl 65:1–3PubMedGoogle Scholar
  42. 42.
    Saeger W, Ludecke DK, Buchfelder M, Fahlbusch R, Quabbe HJ, Petersenn S (2007) Pathohistological classification of pituitary tumors: 10 years of experience with the German Pituitary Tumor Registry. Eur J Endocrinol 156:203–216CrossRefPubMedGoogle Scholar
  43. 43.
    Saeki N, Nakamura M, Sunami K, Yamaura A (1998) Surgical indication after bromocriptine therapy on giant prolactinomas: effects and limitations of the medical treatment. Endocr J 45:529–537CrossRefPubMedGoogle Scholar
  44. 44.
    Schaller B (2005) Gender-related differences in prolactinomas. A clinicopathological study. Neuro Endocrinol Lett 26:152–159PubMedGoogle Scholar
  45. 45.
    Schwartz TH, Stieg PE, Anand VK (2006) Endoscopic transsphenoidal pituitary surgery with intraoperative magnetic resonance imaging. Neurosurgery 58:ONS44-51Google Scholar
  46. 46.
    Shimon I, Benbassat C, Hadani M (2007) Effectiveness of long-term cabergoline treatment for giant prolactinoma: study of 12 men. Eur J Endocrinol 156:225–231CrossRefPubMedGoogle Scholar
  47. 47.
    Shrivastava RK, Arginteanu MS, King WA, Post KD (2002) Giant prolactinomas: clinical management and long-term follow up. J Neurosurg 97:299–306CrossRefPubMedGoogle Scholar
  48. 48.
    Steinmeier R, Fahlbusch R, Ganslandt O, Nimsky C, Buchfelder M, Kaus M, Heigl T, Lenz G, Kuth R, Huk W (1998) Intraoperative magnetic resonance imaging with the magnetom open scanner: concepts, neurosurgical indications, and procedures: a preliminary report. Neurosurgery 43:739–747CrossRefPubMedGoogle Scholar
  49. 49.
    Yang MS, Hong JW, Lee SK, Lee EJ, Kim SH (2011) Clinical management and outcome of 36 invasive prolactinomas treated with dopamine agonist. J Neurooncol 104:195–204CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag Wien 2016

Authors and Affiliations

  • Safak Akin
    • 1
  • Ilkay Isikay
    • 2
  • Figen Soylemezoglu
    • 3
  • Taskin Yucel
    • 4
  • Alper Gurlek
    • 1
  • Mustafa Berker
    • 2
    Email author
  1. 1.Faculty of Medicine, Department of Endocrinology and MetabolismHacettepe UniversityAnkaraTurkey
  2. 2.Faculty of Medicine, Department of NeurosurgeryHacettepe UniversityAnkaraTurkey
  3. 3.Faculty of Medicine, Department of PathologyHacettepe UniversityAnkaraTurkey
  4. 4.Faculty of Medicine, Department of OtorhinolaryngologyHacettepe UniversityAnkaraTurkey

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